Pachydermodactyly Associated With Repetitive Body-Focused Behaviors in an Adolescent Male

Abstract

ABSTRACT An 18-year-old male presented to outpatient orthopedics with asymptomatic, slowly progressive swelling of his fingers over the course of 2 weeks. Radiographs were unremarkable, which prompted a referral to dermatology. Examination revealed firm fusiform swelling of the proximal phalanges, sparing the thumb and interphalangeal joints. The overlying skin appeared normal. A skin biopsy was performed by the punch technique. Dermatopathology revealed excessive dermal mucin without fibrosis or inflammation to establish the diagnosis of pachydermodactyly, a disorder most common in adolescent males and associated with repetitive rubbing of the fingers or cracking of the knuckles. The patient's mother reported that he had a habit of cracking the finger joints. The patient was advised to discontinue this behavior; however, no improvement was reported on follow-up.